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Vehicle Purchase Contract
Stock#
County
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Date: ° Salesperson:
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Buyer Last Name. " RE'r'st Middle
Address: „ d"m CCity: State: Zip:
z
x
Driver's Lic. # PH: Res. Bus: D.O.B.:
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Co-Buyer Last Name: First Middle
Address: City: State: Zip:
Driver's Lic. # PH: Res. Bus: D.O.B.:
3
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Lien Holder Address:
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insurance Company Policy# Phone
Please Enter My Order For: New❑ Used ❑
Ye
Make
ar ,., Modef " s _Body
a
Vin # w P_a Ag �Lic. # Mileage Color :" .
Make of Used Car Trade In
Price of Vehicle ` $ :k
Year Body Type Model _ _ W Options $
Mileage License
Serial# — — Total Vehicle Price $
Less-Trade-In Allowance $
IMPORTANT The information you see on the window form for this - ---
vehicle is part of this contract. Information on the window form overrides Taxable Amount �— $
any contrary provisions in the contract of sale. Safes Tax $ r
_ _ _
Any motor vehicle sold to Purchaser by Dealer under this Order is sold Document Administration Fee $
WITHOUT WARRANTY, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED —
WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PUR- License Fee $
POSE as to its condition or the condition of any part thereof except as may be Title Fees J $
specifically provided in a separate writing furnished to Purchaser by Dealer. BUYER _ f
SHALL NOT BE ENTITLED TO RECOVER FROM THE SELLER ANY CONS& Transfer Tax $ s
QUENTIAL DAMAGES, DAMAGES TO PROPERTY, DAMAGES FOR LOSS OF
USE, LOSS OF TIME, LOSS OF PROFITS OR INCOME OR ANY OTHER Public Safety Vehicle Fee $
INCIDENTIAL DAMAGES. The Seller neither assumes nor authorizes any other State/Deputy Filing Fee $
person to assume for it any liability in connection with the sale of such vehicle. This -
disclaimer in no way affects the terms of any remaining Manufacturer's warranty. Vehicle Service Contracts $
— — i
POLLUTION CONTROL SYSTEM DISCLOSURE Subtotal $
In order to comply with the Minnesota Statutes,Section 325E.0951,no person may Lien Balance on Trade-in $
transfer a motor vehicle without providing a written disclosure to the transferee _
(buyer)certifying the condition of the pollution control system.
Less Cash Deposit $ I
Transferor (seller) hereby certifies, to the best of his/her knowledge, that the
pollution control system on this vehicle,including the restricted gasoline pipe,has Less Cash Down $
not been removed,altered,or rendered inoperative.
$ k
x
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Transferor's(S6`1ler's),Signature Transferee's(Buyer's)Signature Balance Due on Delivery $ I
IMPORTANT; THIS MAY BE A BINDING CONTRACT AND YOU MAY LOSE
THIS ORDER IS",NbT,BINpJNG UNTIL ACCEPTED BY DEALER. ANY DEPOSITS RM ACCORDING TO ITS TERMS.
Accepted By _ X
" Buyers Signature Accepting
X
Terms of Contract
0",AbRTI-ILAND 1990 Reorder: NORTHLAND•850 E.Cliff Road-Burnsville, MN 55337.952/894-1766-PART#6A s